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Meta-analysis of Randomized Trials Comparing the Effectiveness of Miniaturized versus Conventional Cardiopulmonary Bypass in Adult Cardiac Surgery
  1. Fausto Biancari (faustobiancari{at}yahoo.it)
  1. Oulu University Hospital, Department of Surgery, Oulu, Finland
    1. Riikka Rimpiläinen (riikka.rimpilainen{at}ppshp.fi)
    1. Oulu University Hospital, Department of Anesthesiology, Oulu, Finland

      Abstract

      Objectives: The aim of this meta-analysis is to summarize the results of prospective, randomized studies comparing miniaturized (Mini-CPB) versus conventional cardiopulmonary bypass (C-CPB).

      Design: Meta-analysis of randomized trials.

      Setting: University Hospital.

      Methods: After retrieval from literature search of 33 comparative studies, 13 studies have been included in this meta-analysis.

      Results: There were 562 patients in the Mini-CPB group and 599 in the C-CPB group. Mini-CPB was associated with somewhat lower mortality during the immediate postoperative period (1.1% vs. 2.2%, O.R. 0.58, 95%CI 0.23-1.47, p=0.25). Postoperative stroke rate was significantly lower in the Mini-CPB group (0.2% vs. 2.0%, O.R. 0.25, 95%CI 0.06-1.00, p=0.05). The length of stay in intensive care unit was similar in the study groups (mean difference: -0.01, 95%CI -0.14-0.12, p=0.87). Mini-CPB was associated with a significantly lower amount of postoperative blood loss (mean difference: -96.55, 95%CI -147.48- -45.62, p=0.0002) along with higher platelets count 6 hours after surgery (mean difference: 23 480, 95%CI 2 130-44 830, p=0.03). The risk of resternotomy for bleeding was similar in the study groups (O.R. 1.06, 95%CI 0.32-3.57, p=0.92).

      Conclusions: This meta-analysis suggests that the use of Mini-CPB may be associated with lower risk of postoperative stroke and blood losses and with a somewhat decreased mortality. However, due to the large heterogeneity of methods and the small number of studies and patients so far evaluated, larger and homogeneous studies should be performed to get more conclusive results on the safety and efficacy of Mini-CPB.

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